Prevalence of Type 1 Diabetes-Related Autoantibodies in Adults With Celiac Disease

Diabetes Care, May 2003

Graziella Bruno, Silvia Pinach, Silvia Martini, Maurizio Cassader, Gianfranco Pagano, Carla Sategna Guidetti

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Prevalence of Type 1 Diabetes-Related Autoantibodies in Adults With Celiac Disease

Results from a population-based survey 5 0 Laboratory of Pediatrics and Neurology, University Medical Center Nijmegen, the Netherlands. MD, Division of General Internal Medicine, Medisch Spectrum Twente , P.O. Box 50000, 7500 KA En- schede , The Netherlands 1 De- partment of General Internal Medicine, University Medical Center Nijmegen, the Netherlands; and the 2 Department of Endocrinology, University Medical Center Nijmegen , the Netherlands; the 3 Department of Laboratory Medicine, Mie Uni- versity School of Medicine , Mie , Japan. Third Department of Internal Medicine, Mie Univer- sity School of Medicine , 2-174 Edobashi, Tsu, Mie 514-8507 , Japan 4 Third Department of Internal Medicine, Mie University School of Medicine , Mie , Japan; and the 5 From the Department of Economics, Moore School of Business, University of South Carolina , Colum- bia, South Carolina. PhD , Department of Economics, Moore School of Business, University of South Carolina , Columbia, SC 29208 6 Department of Internal Medicine, Univer- sity Medical Center , Utrecht, the Netherlands. Haeften, MD , Department of Internal Medicine , G 02.228 , University Medical Center , P.O. Box 85500, 3508 GA Utrecht , The Netherlands 7 Department of Biomedical Genetics, Uni- versity Medical Center , Utrecht , the Netherlands - O agnostic proficiency of the World ur objective was to evaluate the diHealth Organization (WHO) and the National Cholesterol Education Program (NCEP)-III definitions (1,2) for the metabolic syndrome in a Mexican nationwide, population-based survey. Details of the sampling procedures have been previously described (3). The population was composed of 2,158 men and women aged 20 69 years sampled after a 9- to 12-h fasting period. For the WHO criteria, insulin resistance was diagnosed if a nondiabetic case had fasting insulin concentrations 126 pmol/l (21 U/ml) (75th percentile in Mexican adults). The ageadjusted prevalence was 13.61% for the WHO criteria (n 268) and 26.6% for the NCEP-III definition (n 574). After excluding patients with diabetes, the prevalence was 9.2 and 21.4%, respectively. The agreement between the definitions was assessed in 1,969 subjects; 189 cases were eliminated due to the lack of a urine sample. The number of abnormal cases was lower using the WHO criteria. Only 237 of the 545 subjects (43.4%) who fulfilled the NCEP criteria were diagnosed as affected using the WHO definition. Just 16 of 253 cases (6.3%) detected by the WHO definition did not fulfill the NCEP definition. The agreement between the criteria was moderate ( 0.507). On the other hand, the subjects diagnosed using the WHO recommendations had a worse profile than the cases detected by the NCEP-III definition onlythey had a higher BMI and higher non-HDL cholesterol, triglyceride, and glucose concentrations. The demonstration of insulin resistance among the nondiabetic population caused the lack of agreement in 202 of the 242 cases that fulfilled the NCEP definition but failed the WHO criteria. Other reasons for disparity were the higher thresholds used by the WHO criteria; these differences explained the lack of agreement in 66 of the 152 cases with diabetes. In conclusion, the prevalence of the metabolic syndrome is influenced by the selection of the diagnostic criteria. The WHO criteria identified a lower number of cases than the NCEP-III definition. These differences were explained mainly by the inclusion of abnormally high insulin concentrations as a diagnostic criterion. However, the presence of insulin resistance may help to identify patients more severely affected (4). CARLOS A. AGUILAR-SALINAS, MD1 ROSALBA ROJAS, PHD2 FRANCISCO J. GO MEZ-PEREZ, MD1 VICTORIA VALLES, MD1 JUAN MANUEL ROS-TORRES, MD1 AURORA FRANCO, PHD2 GUSTAVO OLAIZ, PHD2 JUAN A. RULL, MD1 JAIME SEPULVEDA, PHD2 From the 1Departamento de Endocrinologa y Metabolismo del Instituto Nacional de Ciencias Medicas y Nutricio n Salvador Zubiran, Mexico City, Mexico; and the 2Instituto Nacional de Salud P ublica, Cuernavaca, Morelos, Mexico. Address correspondence to Carlos Alberto Aguilar-Salinas, MD, Vasco de Quiroga 15, Mexico City 14000, Mexico. E-mail: . 2003 by the American Diabetes Association. References 1. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 285: 2486 2497, 2001 2. Alberti FGMM, Zimmet PZ: Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 15:539 553, 1998 3. Aguilar-Salinas CA, Rojas R, G omez-Perez FJ, Garca E, Valles V, Ros-Torres JM, Franco A, Olaiz G, Sepu lveda J, Rull JA: Prevalence and characteristics of earlyonse (...truncated)


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Graziella Bruno, Silvia Pinach, Silvia Martini, Maurizio Cassader, Gianfranco Pagano, Carla Sategna Guidetti. Prevalence of Type 1 Diabetes-Related Autoantibodies in Adults With Celiac Disease, Diabetes Care, 2003, pp. 1644-1645, 26/5, DOI: 10.2337/diacare.26.5.1644